Provider Demographics
NPI:1992800338
Name:ANDERSON, PAULINE (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1982
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-1682
Mailing Address - Country:US
Mailing Address - Phone:941-359-2452
Mailing Address - Fax:941-359-6541
Practice Address - Street 1:1949 NORTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234
Practice Address - Country:US
Practice Address - Phone:941-359-2452
Practice Address - Fax:941-359-6541
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056152207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212766Medicaid
E07721Medicare UPIN
FL212766Medicaid